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  • Review Article
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Procoagulant therapeutics in liver disease: a critique and clinical rationale

Nature Reviews Gastroenterology & Hepatology volume 11, pages 675–682 (2014)Cite this article

Subjects

Key Points

  • International normalized ratio values in liver disease might be falsely elevated, thus caution should be taken when using this value to consider fresh frozen plasma repletion

  • Cryoprecipitate should be used in the setting of fibrinogen deficiency for proper clot formation

  • Platelet transfusion to at least 50,000/dL can result in adequate thrombin production in the setting of liver disease

  • In cirrhosis patients with chronic inflammation, hyperfibrinolysis can be present and can be treated with antifibrinolytics to promote clot stabilization

  • The knowledge of the coagulation profile for cirrhosis patients is rapidly evolving, future studies might provide further insight into other procoagulant therapies

Abstract

The complex nature of haemostasis in patients with liver disease can result in bleeding and/or thrombosis. These opposing outcomes, which have multiple contributing factors, can pose diagnostic and therapeutic dilemmas for physicians. With the high rate of haemorrhagic complications in patients with cirrhosis, we examine the various procoagulants available for use in this population. In this Review, we describe the clinical and current rationale for using each of the currently available procoagulants—vitamin K, fresh frozen plasma (FFP), cryoprecipitate, platelets, recombinant factor VIIa (rFVIIa), antifibrinolytics, prothrombin concentrate complexes (PCC), desmopressin and red blood cells. By examining the evidence and use of these agents in liver disease, we provide a framework for targeted, goal-directed therapy with procoagulants.

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Figure 1: Procoagulant blood products derived from whole blood.
Figure 2: Site and mechanism of action for procoagulant blood products.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, PO Box 800708

    Neeral L. Shah, Nicolas M. Intagliata, Patrick G. Northup, Curtis K. Argo & Stephen H. Caldwell

  2. University of Virginia, Charlottesville, 22908, VA, USA

    Neeral L. Shah, Nicolas M. Intagliata, Patrick G. Northup, Curtis K. Argo & Stephen H. Caldwell

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  1. Neeral L. Shah
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Correspondence to Neeral L. Shah.

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Shah, N., Intagliata, N., Northup, P. et al. Procoagulant therapeutics in liver disease: a critique and clinical rationale. Nat Rev Gastroenterol Hepatol 11, 675–682 (2014). https://doi.org/10.1038/nrgastro.2014.121

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